Skip to Main Content


  • • Severe, diffuse abdominal pain

    • Gross or occult intestinal bleeding

    • Minimal physical findings

    • Radiographic findings of vascular occlusion

    • Operative findings of ischemic bowel




  • • Predominantly a disease of the elderly

    • Tissue injury is caused by both ischemia itself as well as reperfusion

    Mesenteric arterial emboli (50%): Commonly originate from mural thrombus in an infarcted LV or clot in a fibrillating LA

    Thrombosis of a mesenteric artery (25%): The end result of atherosclerotic stenosis; often a history of intestinal angina

    • Rare causes of acute arterial occlusion include:

    • -Dissecting aortic aneurysm

      -Connective tissue disorders

      -Cocaine ingestion

    Thrombosis of mesenteric veins (5%): Associated with portal hypertension, abdominal sepsis, hypercoagulable states, or trauma

    • Nonocclusive mesenteric ischemia accounts for the remaining 20% of cases of mesenteric ischemia


Symptoms and Signs


  • • Severe, poorly localized abdominal pain that is often out of proportion to physical findings

    • Nausea and vomiting

    • Diarrhea

    • Shock

    • GI bleeding

    • Abdominal distention

    • Abdominal tenderness

    • Peritonitis


Laboratory Findings


  • • Leukocytosis

    • Serum amylase is elevated

    • Significant base deficits

    • Increased serum phosphate

    • Anemia

    • Increased serum lactate

    • Antithrombin III deficiency and other abnormalities of coagulation should be sought in cases of venous thrombosis


Imaging Findings


  • Abdominal x-ray:

    • -Nonspecific

      -Absence of intestinal gas

      -Diffuse distention with air-fluid levels

    Specific findings occur late

    • -Intramural gas

      -Gas in the portal venous system

    GI contrast radiography: Thumbprinting and disordered motility

    CT scan

    • -Diffuse distention with air-fluid levels

      -Intestinal wall thickening

      -Intramural gas

      -Gas in the portal venous system

    Mesenteric arteriography: The gold standard showing disrupted intestinal arterial blood flow or absence of a venous phase


  • • Survival depends on diagnosis and operative treatment within 12 hours after onset of symptoms

    • In the early stages, there is a striking paucity of abdominal findings

    • Pain out of proportion to the objective findings is a hallmark of mesenteric vascular occlusion

    • Later in the disease course, abdominal distention and tenderness occur

    • Shock and generalized peritonitis eventually develop

    • Causes of hypercoagulability should be sought postoperatively in cases of venous thrombosis


Rule Out


  • • Acute pancreatitis

    • Strangulation obstruction

    • Nonocclusive intestinal ischemia


  • • CBC

    • Serum electrolytes

    • Serum amylase

    • Serum lactate

    • ABG measurements

    • Abdominal x-ray

    • CT scan

    • Arteriography

    • Hypercoagulable studies (venous thrombosis)


When to Admit


  • • All cases




  • • Resection of all involved gut; revascularization of proximal stenosis indicated to salvage viable bowel; thrombectomy usually unsuccessful

    • Role of angioplasty and stenting combined with operation depends upon the precise vascular lesions




  • • Acute arterial embolism or thrombosis

    • Acute ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.